pain psychologist???
 

the physiatrist I was seeing at the local large university has been promoted and is no longer seeing patients. They refered me to another physiatrist, who can't help me at all, but at least she said so.... not even close to what she works with (spinal injuries)... anyway, while she looks for another doctor that does deal with RSD for me, she recommended I see a pain management psychologist. To learn how to "cope with chronic pain" and biofeedback etc.

I am not sure this will do anything but get co-payments from me. I don't feel depressed. I do some meditation to control pain now.. it has helped me as much as any pain med, as the meds don't work. But, this doctor felt sure I could benefit from seeing this psychologist. SHe said sometimes it "just helps to have someone to talk to about it" - but I really have not felt the need to go to a stranger and talk about this. When I need to talk I come here, to this board, where people really understand.

As RSD goes, I function fairly well... I still hurt a LOT, but I do still work, and I manage without regular pain meds (mainly because I have not found anything that works anyway) . I take topamax, namenda and norvasc to control the RSD symptoms. Sometimes aleve. Sometimes tramadol, sometimes a couple vicoden... like once or twice a month.

Anyone see one of these doctors? See any reason for me to do this? I have never been one to talk things out, or seek counceling. But, I am also open to anything that will help me. Just not sure what they do, or what to expect.
THanks
Jules

Hi Jules,

Talking to someone can always help with the anxiety of what life is giving you right now. Biofeedback can be helpful for some, they just put leads on you and teach you to control your breathing to try to control your pain. You know yourself, but maybe you should give her a try and see if it is helpful, if not you have the right to find someone else. You were already seeing someone, was it helpful? If you feel you need to talk to someone, you should go and give it a try. I wish you many pain free days.

Sandy

You're doing just fine on your own...
 

Hi Jules,

It sounds to me that you are managing things quite well on your own. You should be very proud of yourself!

I agree with you that this is the place to come where we can talk to like minded individuals about our feelings and experiences with RSD.

I'm at the same spot as you, I seem to manage well by applying multiple therapy strategies with minimal pharmacological interventions to help control the pain. That being said I always have in the back of my mind that speaking with a professional might give me some deep insight that I haven't come across on my own. For some people therapy is essential, I've always looked at it as a tool to help put one back on the right track when getting off course. I can't afford therapy right now so it's not really an option at this time for me. That being said if your co-pays are reasonable and if it is with a psychologist who specializes in Pain Management it could well be worth it. If it's simply a matter of a crap shoot on the part of the referring physician who feels bad that he/she can't help you I'd make a pass. Pat yourself on the back for doing as well as you are.

MsL

Hi Jules,
I was refered to a pain psychologist by my pain management doc several months ago..

Because I have practically no remaining 'sick leave' hours due to injury/surgery and countless doctor appointments I've had in the last three years, I see her during my lunch time..I eat lunch on the freeway on the way to her office weekly!! this aspect is stressful...oh well....

Nevertheless, it took a while for our relationship to be established, and for me to feel comfortable with her..we have different personality types..she is very reserved, whereas I am more animated. At first her demeanor intimidated me...I felt uneasy in expressing my emotions and thoughts...

Over time, though, I have relaxed and we have a decent rapport.
In several meetings, a floodgate of emotion has poured forth with tears, sobbing, and talking out my frustration, demoralization, anger, exhaustion, and pain. It is helpful to have this interpersonal encounter...

I have developed a great appreciation for this hour with her, as it is a time to be face to face with a person who doesn't judge me and who is there to listen to my defeats and victories, my tears, or expression of hope, and the 'RSD loneliness.'

She also is teaching me a technique called "autogenics" where she helps me get into a very deep state of relaxaton. She was a physcial therapist for many years, and truly does understand the dynamics of pain.

She has also provided me with a great book called "Managing Pain Before it Manages You" as well as a couple of relaxaton C.D.s
While she will never truly viscerally understand the experience of RSD pain, and the frustration of limited mobility, it is a place for me to 'unload.'

Jules, I would give it a try...it takes time to make a connection with a therapist...sometimes it is instantaneous, and for others it builds slowly.....
I am very fortunate that W.C. is authorizing these sessions.

It is their 'gift' to me to keep me in the workforce (pardon my cynicism...)

I try and manage my pain with meditation, and relaxtion techniques that I've explored on my own..I've declined meds except for neurontin, which has enough side effects of its own...I know at some point, I may have to add more meds...I'm so grateful for the mobility scooter..

If you decide to add this avenue of relief, I hope have a positive experience!!
Hope4thebest :hug:

Jules -

Following specifically on what Mslday and hope4thebest said, there is a clarification from my experience that might be helpful.

Too long ago, about a year into this, I was being treated at the pain clinic of a good hospital in town, when somehow or another, I was referred to its on staff psychologist. As it turned out, he was the only person on the clinic's professional staff who wasn't a network provider on my health insurance. (Such a waste of money.) At one point I said that the key issue I was having was an increasing inability to control my frustration/temper, not with family and friends, but sales clerks, telephone representatives, etc. To which he responded there really wasn't much I could do about it, that it "went with the territory" of chronic pain.

Shortly thereafter, and for unrelated reasons, I left that pain clinic and began being treated by a wonderful (and now semi-retired) neurologist who specialized in neurological rehabilitation and pain management, to whom I had happened to have been referred four or five years earlier for compressed cervical disks. And he wanted me to see his pain psychologist. In addition to being a licensed clinical psychologist, she is also a psychoanalyst, specializing in pain management. I had one 2 hour evaluation with her, but that's all it took. I told her about the "went with the territory" remark, to which she said (in so many words) that it would make excellent organic fertilizer and then handed me the card of an MBSR instructor, which changed my life forever.

Bottom line: there are psychologists who happen to have gotten a job in a pain clinics and call themselves pain psychologists, and then there are those psychologists to whom neurologists (or anesthesiologists or physiatrist) with many years experience in treating chronic pain refer their patients. Wherever possible, I would seek out the latter. Can you get such a referral from the spinal injury physiatrist with whom you spoke? At least in my understanding of the world, chronic pain is chronic pain when it comes to psychology.

Mike

ps For a great introduction from a meditative perspective, I would strongly endorse Shinzen Young's
Break Through Pain: A Step-by-Step Mindfulness Meditation Program for Transforming Chronic and Acute Pain (2005) (1.25 hour CD plus 80-page hard cover book Published by Sounds True). His primary website is http://shinzen.org/ and he has been my teacher since 2003, turned out the MBSR teacher - and still close friend - was also someone who works closely with him.

Sandy said "You were already seeing someone, was it helpful?" - Sandy, I think you mis-read my post. I was seeing a physiatrist, which specializes in movement and rehabilitation. He is the one who got promoted.

My insurance will only cover 6 visits per year to a psychologist. Don't think I can get much of a relationship going in that time. LOL

This psychologist specializes in pain. I was referred to her by the doc that took over for my physiatrist... that doc specializes in spinal injury... and rehab, so I imagine she deals in pain quite a bit. She really thought that this would help, and was surprised that in the 9 years I have had RSD, no one has suggested I see a psychologist before.

Michael - your the one who got me "into" Shinzen Young. Was the biggest help for my RSD yet. I have never felt like I really do mediation fully, or deeply, or what ever - but what I do helps, and that is the important part. The main thing I got from his book was not to be afraid of the pain. Not to be tense about it, because it only makes it worse.

I go to the Cleveland Clinic this week, for a check by a doctor I saw up there a few years back. I think she really knew her stuff. She worked with Stanton-Hicks for many years, now runs the pain management at one of the hospitals in the area. Since my RSD has changed lately, I wanted to be seen by someone who has a clue. She is the closest thing to an RSD specialist I have been able to find.

Thanks everyone.
Jules

Hi Jules,

I have been seeing a pain managment phsycologist for the last 3 years. He is great and has taught me a lot about relaxing and breathing through my pain. He is also very helpful with helping to sort out treatment options. He has several RSD patients.

I noiticed you are from OH. I live is southwest OH and see a wonderful doctor in Hamilton.

I wish you the best of luck!!
Sherrie

Unfortunately, even though I am entitled to psych therapy benefits under RI State Law, the Hartford has denied all of my psychologist's bills as she has submitted them for payment. I just found out that her bills have been denied by worker's comp last Friday - she didn't tell me, my attorney did. Apparently she'd known for a while and didn't want me to know. My attorney has filed a 21-day motion, which means that if The Hartford doesn't pay my doctor within 21 days of the date of the notice, then my attorney will take them to court to get her paid. Since the inception of my illness my attorney has had to take the Hartford to court at least a dozen times for non payment of bills for my care for stuff that I am entitled to under the WC law. All of my legal bills are paid by the Hartford.

I decided that I needed to start talking to someone once I stopped working, because the disability LOA was so hard for me to accept. Maybe it was because I had more time to think about my illness, but I started to have terrible crying spells during the month of July. I have seen my psychologist 7 or 8 times, and we have started to develop a very nice relationship. I really like her. By now she understands a lot about me. It is SOOO humiliating that she is rendering services and hasn't been paid yet. Admitedly, she accepted me a patient knowing the deal with WC because I explained how evil they were the first day I was there, and the entire set-up regarding her bills and how they needed to be submitted. I made sure she knew what she would be dealing with when she took me on, and let her know I had back-up insurance just in case (which will be very expensive for me if I have to use it, and SO UNFAIR). Under the law, I am entitled to psych counseling.

I honestly believe that I would not be as sick as I am if I had a better WC insurance company to work with. Every time these guys these guys torture me with a new denial I flare. (she is teaching me the breathing techniques and I should be getting better at dealing with that).

Those of you that are WC that have decent adjusters with a conscience and a sense of fairness that approve the services that you are entitiled to should count your blessings. You have no idea just how lucky you are!!

Thanks for listening to me vent (for the umpteenth time!) about the Hartford!!

two more meditation options
 

Dear Jules -

Please excuse my poor memory. It's become an issue in my life.

As to deepening your meditation practice, there are a couple of good options that come to mind. The first is an 8 week MBSR (Mindfulness-Based Stress Reduction) class (total cost approx. $500), which is centered around weekly 2 and 1/2 hour classes/group discussions/guided meditations etc., tapes on guided meditations and yoga to be used on hopefully a daily basis in between, and a day long retreat at the end of the program. The program has been run out of the Univ. of Mass. Medical school for over 30 years, for many years by by Jon Kabat-Zinn, PhD, who's a very interesting guy in his own right. Here are the first two paragraphs of his online bio:

JON KABAT-ZINN, PH.D., is founding Executive Director of the Center for Mindfulness in Medicine, Health Care, and Society at the University of Massachusetts Medical School. He is also the founding director of its renowned Stress Reduction Clinic and Professor of Medicine emeritus at the University of Massachusetts Medical School. He teaches mindfulness and Mindfulness-Based Stress Reduction (MBSR) in various venues around the world. He received his Ph.D. in molecular biology from MIT in 1971 in the laboratory of Nobel Laureate, Salvador Luria.

He is the author of numerous scientific papers on the clinical applications of mindfulness in medicine and health care, and of a number of books for the lay public: Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain and Illness (Delta, 1991); Wherever You Go, There You Are: Mindfulness Meditation in Everyday Life (Hyperion, 1994); Coming to Our Senses: Healing Ourselves and the World Through Mindfulness (Hyperion, 2005); and Arriving at Your Own Door: 108 Lessons in Mindfulness (Hyperion, 2007). He is also co-author, with his wife Myla, of Everyday Blessings: The Inner Work of Mindful Parenting (Hyperion, 1997); and with Williams, Teasdale, and Segal, of The Mindful Way Through Depression: Freeing Yourself from Chronic Unhappiness (Guilford, 2007). Overall, his books have been translated into over 30 languages. . . .

http://www.umassmed.edu/Content.aspx?id=43102

The MBSR mainpage is at http://www.umassmed.edu/Content.aspx...d&itemid=41254 including a link at the bottom to finding teachers in your area. As much as it troubles me to admit it, nothing I have done since then, including 2 week residential retreats, has focussed me on daily commitment to practice as much as that first MBSR class.

A less expensive option is Shinzen's whole new baby, Basic Mindfulness: Home Practice Program Phone-based Classes & Retreats at http://www.basicmindfulness.org/ It's a series of 2 - 4 hour classes, mostly guided mediations taught most by Shinzen himself, that meets over an entire weekend, 2 hours on Friday night and two 4-hours sessions on both Sat. and Sun., once a month. The cost of each class ranges from $10 to $20 each, however, no one will be turned away for lack of funds. The upcoming October program (Oct. 11 - 13) will, however, be taught be a couple of his senior students, where Shinzen will be on retreat in Israel.

The techniques is set around a program Shinzen calls 5 Ways to Know yourself as a Spiritual Being - an article laying out the entire structure can be opened at http://www.shinzen.org/Retreat%20Rea...20Yourself.pdf - and while most of the classes have a prerequisite, each month there is one totally intro class open to all. In October it's "Focus on Change: Part 1." The idea being that each of the basic techniques (all distilled from thousands of year of organized practice, and each can be footnoted at legnth). With each of the 5 basic techniques, you take Part 1, followed by Part 2 at a later date. However, if Part 2 of the class you've started isn't available on the following month, you're free to take Part I for any other technique. Then, as soon as you have Parts I and 2 down for any one of the techniques, you can take any "elective" on which it's based. And once you've covered all five techniques, it's as though you have just completed a week-long residential retreat and you're good to go with everything on the menu.

I just noticed, for perhaps this month only, there is a 2 hour guided overview of the 5 Ways with no prerequisites, led by Stephanie Nash - who's great - on Friday night, October 9, 2009. (Go to the basicmindfulness.org page http://www.basicmindfulness.org/ and click on the "Monthly Schedule tab at the top of the page.) For $10 this is an opportunity not to be missed.

Hope this is useful.

take care,
Mike

Dear Sandy -

I can't believe what you and almost everyone on WC has to go through: until I got on the boards, I didn't realize how "lucky" I was to have been injured at the gym.

RI is small enough state, however, for a couple of determined people to have an impact through it's legislature. It might be worth finding out if there is a WC patient advocacy group already set up, and then getting in your two cents.

In the meantime, all I can say is that you are clearly a strong person for being able to cope with this much frustration, as well as you are. (Believe it or not.)

hang in there,
Mike

ps re two more meditation options
 

Just noticed this class description from Shinzen's November schedule. Although Break Through Pain doesn't have anything remotely approaching this level of complexity, he is - as you can see - an interesting guy:

NOVEMBER 15 (Sunday AM) - Exploring Sight Space
5:00 am to 9:00 am Pacific / 8:00 am to 12:00 pm Eastern

Sharpening the technique, led by Shinzen Young

Prerequisites: Previous experience in practicing Focus In and Focus Out.

Comments: Of the various senses, external sight might be described as the "orphan child" of Mindfulness Practice. People can usually get into their body sensations, thoughts or focusing on sound, but working with Sight Space is often seen as difficult, mysterious and perhaps even undesirable. The purpose of this program is to show you how easy, interesting and productive it can be to work with the sights of the world and your subjective reactions to them.

In previous historical periods, people often had the idea that to experience "spirit" one needs to transcend "matter" or that matter is in some way the enemy of spirit. Actually the world around us seems material simply because we constantly microscopically "fixate" the external seeing process. All you need do to "go beyond the materiality of the world" is to have a complete—i.e., fully clear and fully equanimous—experience of seeing the world.

Einstein once said that matter (in the physicist’s sense…a measure of inertia and gravitation attraction) is just frozen energy. Similarly matter (in the perceptual sense) might be described as frozen seeing. In this program you’ll explore the thawing of the world—a first step toward making all of your day-to-day visions Beatific.

Suggested Reading: Focus Out Summary - http://www.shinzen.org/Retreat%20Rea...ut-Summary.pdf

Fee: $20 per person (This fee does not include charges, if any, by your long distance phone service.)

http://www.basicmindfulness.org/

As far as the (very) early hour goes, Shinzen rotates his Sat./Sun. starting times, so one day is convenient for folks on the East Coast, while the next works better on the West Coast. And any newcomers never fear, the introductory or "foundational" classes are always in the afternoon.

Well, I have seen the psychologist 3 times. I took some sort of personality test after the first session. It was 375 questions, if I remember right. All sorts of things. Covered topics like relationships, work, hobbies. There were a couple questions I was hesitant to reply truthfully to. One was something like "Do you like knives" and the other "Do you like guns".... LOL I really love to cook and I have a fabulous set of knives. And, I used to target shoot all the time, have several guns... but never in my life have I ever thought of using either a knife or a gun on anyone, or myself.

I did find out that I scored as having significant Social Phobia - I didn't understand what this meant at first, and we had to go over it many times. I have always been a "loner"... I hate going anywhere where there are people. I even worked 2nd shift so that I usually worked alone in my department.

The other surprise was that I scored as having Major Depression. I never thought of myself as depressed. But, I had 9 traits of it, some pretty severe.

Last, I scored high as having a chronic pain disorder. DUH!

I happened to talk to the lawyer that has answered my questions about filing for disability, and he says that these diagnosis should help me to get disability.

We have not discussed treatment yet - but my homework was to re-read Shinzen Young's book. She was very familiar with it. I have been sick with a horrid cold, and have not been out to get it from the friend that borrowed it. I go back to her a week from today, so I should still be able to get it by then.

The doc thinks that she can help me cope with RSD. She works only with people in severe pain, or are disabled.

I have always had a terrible time with anti-depression meds. They make me feel worse, gain weight and don't do anything for my pain. This doc seemed to think that we could work on things without meds. She said some people are very sensitive to them, and I sounded like one of them. She said I am better off working on the underlying issues anyway.

We talked about about how I was as a teenager, my relationships, the personalities of my close friends.... and she thinks I have had these issues for 30 years, and the reason I don't feel depressed is that I have been this way for so long, it feels normal.

Does any of this sound like I am on the right track?

I may be off topic a bit, but I'd like to add,
That I've been through Bio - Feedback before I was dx'd with rsd. It was an TMJ doctors office. Even though that was about 20 years ago, I can still use what I was taught for pain relief.

I really enjoyed reading all your stories about psychol and psychiatrist. (if that makes sense), I've been through that too.
At one time when the pain was increasing, and another, to get me off of as many meds as possible, yet still operate. (Raising to young children, and administrating two small busni). cool word, huh?

These "brain doctors" really need to be recomended, and thinned out a bit. Most are good, some are great. But, worth it overall.
This is why Chiropractors do so well, the "hands on" approach, and the talking, and interest they show in you!
This is irreplaceable!

I've been reading a bit all day, because I have other things lately, (a friend with RSD, RA, and CANCER) But, what I read through each and every thread, is the Favorite doctors, are the ones who sit, and spend some time talking with you.

I can't agree more.
It's the one on one, person to person dialect, that make doctors worth what they are.
The best ones, maybe expensive, and take no insurance, but, they need surely spend some personal time with you....

Hope you're all well!

pete
asb

great pain psychologist
 

Mine helps me make plans for what I need to do in order to go anywhere. We also some biofeedback and lots of visualizations to deal with the heat and "lightning". it does help! I also can talk with him about my treatment options, and how everything's going with communicating/planning with my pain drs. we've talked about my concerns about treatments and being comfortable with treatment decisions.

Pain Psychologist???
 

Jules,

You may be very interested in my one and only consult with a pain psychologist. My regular pain management specialist was on an extended trip, and the PA acting for him was requiring that all patients have a consult with the pain psychologist affiliated with their practice during his absence. Convinced this was a waste of my insurance benefits and time, I went armed with a document outlining my illness treatment history.

The pain psychologist listened to my presentation, then proceeded to describe the techniques she used to assist in the management of chronic pain. My response was, "I have only one question. I want your honest evaluation. Do any of these work?"

The response of the PhD Pain Psychologist was honest and chilling, "No, there is no evidence that any of them work. What they do accomplish is to keep patients occupied". And with that we both agreed that not only was there no need to ever see her again, but that there was no reason for me to have ever come in the first place. She called the PA while I sat there and told her as much. Neither my insurance company nor I ever saw a bill.

From the mouth of a UCLA trained PhD Pain Psychologist, "there is no evidence that any of them work". I have always been grateful for her candor.

Perhaps you can bypass the pain psychologist in favor of diversions like pets, reading, friends, the simple daily things in life that we can use to take our minds off the pain of RSD. Best wishes in your journey.

I have been a few time now. We have done nothing to address my pain.

The only reason I continue to go is that her opinion may help me with vocational rehab placement and/or disability.

The first couple visits were occupied with diagnosis and explanation.

The next visit were discussing if I was able to work, and if so, what I might do. Also we discussed my elderly Mom who lives with me, and some ways to cope with her.

Last visit we talked about my lack of concentration, memory problems, learning issues. She helped a little by talking about ways to get around those issues.

I only have 10 visits, so it won't last forever.

She is a nice person. She does not do a lot of "seeing patients" but does more research. I am her first RSD person, and she did mention me coming after my 10 visits are up, at no cost.

I cannot say I have been helped at all so far. But, I have not been "harmed" so I am sticking with it for now. Like I say - the disability lawyer I spoke to said it was great I was going and that the diagnosis/treatment would be very important.

So that is where I am.

Hi. When I did therapy around the RSD it was more about talking about the feelings that come with this condition, how to deal with family/friends,trying to have a fufilling life with the barriers,etc. I feel all therapy because before I had this I was in therapy on and off is a gradual change you will notice. Hopefully you can learn tools that can be used in ever day life. When I went back to psychiatrist part of the reason it took me so long to go was that I thought if someone would fix the horrible pain I would be fine mentally. Well that did not happen and finally I did go back to the psychiatrist and got on meds. I am glad I did though it did not take away the physical pain I mentally deal with it a lot better and I feel that may be the same with therapy. Just some thoughts. Hope you find what works and things with the disability work out